... SAN ANTONIO Feb. 1 /- For the millions of health car...Speaking today at the 66th Annual Meeting of the American Academy ofD... We demonstrated that some people are predisposed to skin reactions to...

SAN ANTONIO, Feb. 1 /PRNewswire/ -- For the millions of health care
workers in the United States, repeated hand washing may not seem like an
occupational hazard at first glance. In fact, good hand hygiene is
essential in health care workers to stop the spread of potentially serious
infections, such as staphylococcus and clostridium. However, new research
examining the risk factors for irritant contact dermatitis -- a common skin
condition marked by scaling, redness, itching and burning due to a chemical
substance on the skin -- among health care workers finds that those who
washed their hands more than 10 times per day were more likely to develop
the condition than those who washed their hands less frequently.

"We demonstrated that some people are predisposed to skin reactions to
irritant detergents, and those who do 'wet' work in low humidity conditions
where frequent hand washing is an essential part of the job are very
susceptible to hand dermatitis," said Dr. Nedorost. "Our findings confirm
that health care workers who wash their hands repeatedly are at an
increased risk of developing hand dermatitis, which can take months to
heal. This knowledge can help workers at risk for the condition to practice
good hand care and follow preventative tips to decrease their risk factors
on the job." Conducted in collaboration with the National Institute of
Occupational Safety and Health (NIOSH), the study included a total of 100
health care workers in Cleveland, Ohio, who washed their hands at least
eight times daily. Study participants were asked to complete a
questionnaire to identify frequency of hand washing, use of alcohol-based
cleansers, history of specific medical conditions (including asthma,
eczema, and psoriasis, among others), and family history of dermatitis or
eczema.

Patch tests to determine how easily the skin was irritated by
detergents also were conducted on the study participants. Low
concentrations of three common detergents were patch tested to predict
which patients were at risk for hand dermatitis.

Data from the questionnaires and patch tests that were analyzed from 60
subjects who completed the study to date found that 63 percent of
participants developed hand dermatitis. Specifically, 22 percent of
participants who washed their hands more than 10 times per day developed
hand dermatitis compared to only 13 percent of those who washed their hands
less than 10 times daily. The researchers determined that neither the use
of an alcohol-based cleanser nor the use of gloves significantly influenced
the development of hand dermatitis, and the other variables assessed in the
questionnaire did not significantly alter susceptibility to hand
dermatitis.

Some study participants had reactions to even low concentrations of
detergent when patch tested, indicating that they were at increased risk
for hand dermatitis likely due to genetic factors. In addition, in
analyzing the patch testing data, Dr. Nedorost determined that the most
important factor in predicting those at risk for hand dermatitis was a
reaction to the detergent sodium lauryl sulfate (SLS). Specifically, the
large percentage of participants who reacted positively to SLS and
developed hand dermatitis far outweighed the number of participants who did
not react positively to SLS, but subsequently developed hand dermatitis.

A secondary goal of this study was to investigate possible associations
of genetic variations in genes susceptible to hand dermatitis. The genetic
analysis is not yet complete, but an example of a candidate gene that may
play a role in hand dermatitis is filaggrin.

"Recently, genetic variants in the gene encoding filaggrin -- a protein
that binds to cells in the outermost layer of skin known as the epidermis
-- have been shown to be strong predisposing factors for atopic eczema, in
which impaired skin barrier function plays a key role," explained Dr.
Nedorost. "Variations in the filaggrin gene may cause a disturbance of the
top layer of the skin, which serves as a barrier against environmental
exposures -- such as frequent wetting and drying of the skin. Once the top
layer of the skin cracks due to frequent wet/dry cycles, especially in
conditions of low humidity where drying occurs rapidly, it results in
inflammation. This is how irritant hand dermatitis begins."

Since environmental factors such as humidity and the need for good hand
hygiene at work are beyond health care workers' control, prevention is the
key to warding off hand dermatitis. Dr. Nedorost recommended the following
tips for health care workers to help prevent hand dermatitis:

-- Cotton gloves should be worn under rubber or vinyl gloves for wet work

to prevent perspiration from dampening the skin. The cotton gloves

should be changed frequently if wet work is prolonged.

-- When appropriate, alcohol-based hand cleansers should be substituted

for hand washing. These cleansers are well tolerated, but may cause

temporary stinging when in contact with skin cracks.

-- A cream or ointment-based emollient should be applied immediately after

water exposure before the skin is completely dry. The goal is to

prevent rapid drying and cracking, so applying the emollient after the

skin is dry is not nearly as beneficial.

Although patients often receive prescriptions for topical
corticosteroids to treat symptoms of hand dermatitis, Dr. Nedorost cautions
that evidence suggests that chronic use of topical steroids may reduce the
skin's ability to tolerate irritants, thins the skin, and increases
bruising and tearing.

"Topical steroids should never be used long term as a substitute for
emollients," added Dr. Nedorost. "Patients should consult a dermatologist
for the proper treatment of hand dermatitis, particularly those who suspect
their work environment may be the culprit."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails. For more information, contact
the Academy at 1-888-462-DERM (3376) or http://www.aad.org.

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